Montolío-Marzo Santiago, Lanzagorta-Aresti Aitor, Piá-Ludeña Jose Vicente, Davó-Cabrera Juan María
FISABIO Oftalmología Médica (FOM), Valencia, España.
Eur J Ophthalmol. 2022 Jan;32(1):NP76-NP78. doi: 10.1177/1120672120970862. Epub 2020 Nov 11.
As minimally invasive glaucoma surgery devices emerge, newer complications are reported. XEN gel stent is safer than classic glaucoma surgery but may also lead to severe adverse effects as hypotony. Compression conjunctival sutures are a useful treatment for overfiltration hypotony after XEN gel stent implantation, but might force bleb tearing by the implant as it gets tightly close to the sutured conjunctiva. This complication has not been previously reported.
We report a patient with overfiltration hypotony after XEN gel implantation. Conjunctival compression sutures and implant relocation ab interno were performed obtaining a good outcome. As conjunctiva got tightly close to the stent, the device eroded the bleb so leakage and implant extrusion were found.
Bleb reconstruction by conjunctival autograft was performed in order to avoid hypotony due to continuous conjunctival leakage.
Conjunctival compression sutures may be used for overfiltration control after XEN gel implantation but we must be aware of potential conjunctival damage due to implant erosion even if it is correctly positioned. Close follow-up and early suture release may be convenient in these patients.
随着微创青光眼手术器械的出现，有新的并发症被报道。XEN凝胶支架比传统青光眼手术更安全，但也可能导致如低眼压等严重不良反应。压迫性结膜缝线是XEN凝胶支架植入术后滤过过度性低眼压的一种有效治疗方法，但当植入物紧贴缝合的结膜时，可能会导致植入物撕裂滤泡。这种并发症此前尚未见报道。
我们报告了1例XEN凝胶植入术后发生滤过过度性低眼压的患者。进行了结膜压迫缝线和经内路植入物重新定位，取得了良好效果。由于结膜紧贴支架，器械侵蚀了滤泡，出现了渗漏和植入物挤出。
为避免因结膜持续渗漏导致低眼压，进行了自体结膜移植重建滤泡。
结膜压迫缝线可用于XEN凝胶植入术后的滤过过度控制，但我们必须意识到即使植入物位置正确，也可能因植入物侵蚀而导致结膜潜在损伤。对这些患者进行密切随访和早期缝线松解可能是合适的。
